A Rare But Serious Side Effect

The television is on. You are watching your favorite show. Then the commercial comes on for one of those cholesterol lowering drugs. Zocor, Vitorin, Crestor, Pravachol, etc…these medications are just a few. The ad tells you how their drug, along with a sensible diet will help lower your cholesterol. They quickly run through the side effects. You hear the announcer say “Tell your doctor if you have muscle weakness or pain, as it can be a sign of a “rare but serious side effect."

Have you ever wondered what this rare but serious side effect is?

My husband suffered from this side effect. It is called Rhabdomyolysis. We had never heard of it before. His doctor never told him about this “rare but serious side effect”. Unfortunately, in 2001, those commercials were not on television.

My husband, who had a heart attack in 2000, was prescribed Zocor (simvastatin) to lower his cholesterol. He had been on Zocor for one year and it was doing it’s job. His cholesterol level was coming down. During this time, we moved to another state and he started seeing another doctor. The new doctor didn’t think his cholesterol level was low enough, so he added another drug called Lopid (gemfibrozil). No education was conducted on what to look for in side effects.

A few weeks after starting the new medication, we took a several hundred mile road trip. Upon returning home, my husband started having hip and thigh pain with mild difficulty walking. He thought the discomfort had been brought on by our long trip by car. He didn’t go to the doctor right away because he had a pending appointment the following Monday.

The following morning, he had trouble getting out of bed and even more difficulty walking. He still wanted to wait for his Monday appointment.

By that afternoon, I had to physically help him off the couch so he could walk to the bathroom. He hollered for me from the bathroom. It was then that I knew something was seriously wrong. His urine was the color of Coca-Cola…dark reddish brown. We went straight to the emergency room.

That was when they made the diagnosis of Rhabdomyolysis. Even though I had been a nurse for many years, this term was new to me. I spent the rest of the night on the internet looking up Rhabdomyolysis. I read every article that I could find on this side effect.

In a nutshell, here is what I discovered:

Rhabdomyolysis is a rare but potentially life-threatening side effect of statins. The most common signs and symptoms of rhabdomyolysis include:

• Severe muscle aching — in which all your muscles may hurt and be tender to the touch
•  Muscle weakness
•  Dark or cola-colored urine from muscle breakdown products (myoglobin)

Myoglobin is an oxygen-binding protein pigment found in the skeletal muscle. When the skeletal muscle is damaged, the myoglobin is released into the bloodstream. It is filtered out of the bloodstream by the kidneys. Myoglobin may block the structures of the kidney, causing damage such as acute tubular necrosis or kidney failure.

Myoglobin breaks down into potentially toxic compounds, which will also cause kidney failure. Necrotic (dead tissue) skeletal muscle may cause massive fluid shifts from the bloodstream into the muscle, reducing the relative fluid volume of the body and leading to shock and reduced blood flow to the kidneys.

At high doses, statin medications can impair production of certain proteins involved in muscle metabolism and function. This may result in muscle pain and tenderness (statin myopathy).

 If you notice muscle aching, and it is not severe, you should stop taking the medication and contact your doctor.

In severe cases, statins may cause muscle cells to break down (rhabdomyolysis). If you have signs and symptoms of rhabdomyolysis, stop taking the medication immediately and seek medical treatment without delay.

The risk of rhabdomyolysis increases with the dose of statins. In addition, certain drugs when taken in combination with statins increase the risk rhabdomyolysis. These include:

•  Gemfibrozil (Lopid)
• Niacin at doses greater than 1.5 grams a day
• Verapamil
• Amiodarone

 My husbands Rhabdomyolysis was very extensive. He suffered severe muscle pain and wekness over his entire body. For all practical purposes, he was like a quadriplegic for a few days. He couldn’t walk, hold his arms up and it hurt his jaws to talk and eat. His blood levels used to determine this disease’s progress were dangerously high. He developed Acute Renal Failure (kidney failure) and had to go on Kidney Dialysis for six weeks. His doctor said that if had not been a physically strong man, he probably would have died.

Eventually, with the excellent care provided by his nephrologist, he pulled through. He was able to come off of the dialysis and regained most of his muscle use. He still has some residual muscle weakness and sometimes has to use a cane to walk. But he is alive and is doing well.

The purpose of this article is to alert you to the fact that if you develop any symptoms that you did not have before taking a new drug--- call your doctor immediately!

Although this was a “Rare But Serious Side Effect” it does occur in a small percentage of people. So, don’t ignore warning signs and always follow up with your physician.

  Nancy Schimpf RN 

References:

Dr. Paul Baggaley

Medline Plus Medical Encyclopedia

The Myocitis Association